Di-2–ethylhexylphthalate (DEHP) Content of Blood or Blood Components Stored in Plastic Bags

Di-2-ethylhexylphthalate (DEHP) is a plasticizer used in the manufacture of plastic bags for blood products, which may be toxic. No more than a trace (less than 0.1 microgram/ml) could be detected in anticoagulants in blood bags, or in the blood of healthy untransfused subjects. A mean of 23 microgram/ml was found in ACD whole blood after 2 weeks storage, and 46 microgram/ml after 3 weeks; the corresponding figures for packed cells were 39 and 45 microgram/ml. The level in CPD whole blood was similar. Fresh frozen plasma and cryoprecipitate contained 7 microgram/ml, while levels of 1.0 and 0.7 microgram/ml of DEHP were found in the blood of two patients who had received massive transfusions. Most DEHP in stored blood was associated with plasma lipoproteins.     

Storage of Platelets in a New Plastic Container: Polyvinyl Chloride Plasticized with Butyryl-n-Trihexyl Citrate

The effect of storage of platelets in a new polyvinyl chloride (PVC) plastic material with a butyryl-n-trihexyl citrate (BTHC) plasticizer (PL 2209) was evaluated. The PL 1240 container, i.e. PVC plastic with a different plasticizer, tri-(ethylhexyl)-tri-mellitate, was used as a reference. Measurements of pH, pO2, pCO2, glucose, lactate, adenosine triphosphate, total adenine nucleotide content, lactate dehydrogenase and platelet factor 4 (PF4) were made during 5 days of storage. Similar results were noted comparing PL 2209 and PL 1240. Differences in pO2 and pCO2 indicate greater gas permeability in PL 2209 than in PL 1240. Significantly higher PF4 levels were found in PL 2209, but the difference could not be attributed to the PL 2209 container itself. Paired autologous reinfusion studies (111Indium) of 6 normal donors gave mean recovery values after 5-day storage of 41.1 +/- 7.4% (PL 2209) and 45.5 +/- 7.7% (PL 1240), t1/2 66 +/- 13 and 75 +/- 5 h, survival time (linear model) 6.3 +/- 1.0 and 6.8 +/- 0.7 and survival time (multiple-hit model) 6.0 +/- 0.7 and 6.5 +/- 0.4 days, respectively. Only the difference in survival time (multiple-hit) was significantly higher in PL 1240. The corrected count increments at 12-24 h following transfusion were 13,300 +/- 10,800 (PL 2209) and 13,600 +/- 11,600 (PL 1240) with no statistically significant difference found. These results indicate PL 2209 as an equivalent alternative to PL 1240 for the 5-day storage of platelets.     

Prevention of Leakage of Di-(2-ethylhexyl)phthalate from Blood Bags by Glow Discharge Treatment and Its Effect on Aggregability of Stored Platelets

Abstract. Platelets storage in glow discharge treated PVC bags was studied. The amount of leaked di-(2-ethylhexyl) phthalate (DEHP) was 150–200 μg/ml/day in the nontreated PVC bags, but only 20–40 μg/ml in the treated bags after 48 h. The adhesion of silicone to PVC was much improved, and consequently, uniform coating with silicone became feasible. The decrease of the ability of platelets to aggregate was accelerated by DEHP. When stored platelets were resuspended in fresh plasma, the ability to aggregate was gradually restored. However, the degree of restoration of the ability of platelets which had been incubated with DEHP was low. When platelets were stored in the glow discharge treated and then silicone-coated PVC bags, their adhesion on the surface and the decrease of their function were prevented.     

Decreased Hemolysis and Lipid Peroxidation in Blood during Storage in the Presence of Nicotinic Acid

BACKGROUND AND OBJECTIVES: There is increase in lipid peroxidation with consequent increase in hemolysis when blood is stored in di-(2-ethyl hexyl)phthalate (DEHP) plasticized bags. Studies carried out by us and others have indicated the ability of red cells to synthesize NAD+ from added nicotinic acid. Apart from the role of NAD+ in glycolysis, NADPH is required for reduction of oxidized glutathione to its reduced form by glutathione reductase. Reduced glutathione is an important antioxidant, which protects cell membrane from oxidative damage. Reduced glutathione is also involved in the regeneration of vitamin E, another important membrane antioxidant. In view of these, a study was undertaken to find out the effect of addition of nicotinic acid to the citrate-phosphate-dextrose-adenine (CPDA) solution on lipid peroxidation and integrity of red cells when whole blood is stored in DEHP plasticized bags. MATERIALS AND METHODS: Blood was collected in Penpol blood storage bags (which is a DEHP plasticized bag) in CPDA solution in the presence and absence of nicotinic acid. Various parameters of lipid peroxidation and membrane stability - level of malondialdehyde (MDA), conjugated dienes, vitamin E, reduced glutathione, plasma Hb and K+, levels of adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) were studied in the blood samples after various periods. RESULTS: Plasma Hb and K+ concentrations were significantly lower in the presence of added nicotinic acid both after 28 and 42 days. Concentration of MDA and conjugated dienes was lower and the levels of reduced glutathione and vitamin E higher in the presence of nicotinic acid. ATP levels were not significantly different, but 2,3-DPG levels were higher. pH of the blood was nearer to 7.0 in the presence of nicotinic acid, while leaching out of DEHP into the blood was significantly lower. CONCLUSION: Inclusion of nicotinic acid in the CPDA solution has a beneficial effect in that (1) it reduces plasma Hb and K+; (2) reduces lipid peroxidation and increases antioxidant protection; (3) maintains pH nearer to 7.0, and (4) decreases the leaching out of DEHP into the blood.     

Decrease in the Concentration of Vitamin E in Blood and Tissues Caused by Di(2-Ethylhexyl) Phthalate, a Commonly Used Plasticizer in Blood Storage Bags and Medical Tubing

Background and Objectives: Significant amounts of di(2-ethylhexyl) phthlate (DEHP) leach into blood stored in DEHP-plasticized PVC bags. The aim of this study was to find out whether DEHP at these low levels has any effect on the concentration of vitimin E, an antioxidant which affords protection against free radical damage. Materials and Methods: DEHP was administered in low doses (150–750μg/100g body weight) to rats intraperitoneally and the concentration of vitamin E in the liver and testes was measured. Concentration of vitamin E was also measured in blood stored in glass bottles in the presence and absence of DEHP and in blood stored in DEHP-plasticized PVC bags. Results: A decrease in the concentration of vitamin E was observed in all cases. Administration of vitamin E to rats and incorporation of vitamin E in the additive solution in the case of blood prevented this decrease. Conclusion: DEHP even at very low doses caused a decrease in the concentration of vitamin E in liver and tests of rats given this substance. Blood stored in DEHP-plasticized bags also showed a decrease in the concentration of vitamin E.     

小剂量辛伐他汀对老年高脂血症疗效和脂质过氧化的影响

为研究小剂量辛伐他汀对血脂和脂质过氧化的影响，对62例老年高脂血症患者采用辛伐他汀治疗12周后，测定其血清脂质、载脂蛋白、丙二醛、超氧化物歧化酶和硝酸盐的含量。结果发现，血清总胆固醇、低密度脂蛋白胆固醇和载脂蛋白B水平较治疗前显著降低（P＜0．001），甘油三酯水平在治疗后4和8周末显著降低（P＜0．05）；丙二醛水平较用药前明显降低（P＜0．001），超氧化物歧化酶活性明显升高（P＜0．001）。而硝酸盐在治疗前后无明显变化。辛伐他汀治疗前超氧化物岐化酶活性与低密度脂蛋白胆固醇、甘油三酯及总胆固醇水平呈显著负相关，治疗12周末丙二醛水平降低与低密度脂蛋白胆固醇和载脂蛋白B水平呈显著正相关。由此提示，辛伐他汀可改善体内脂质代谢异常，减轻脂质过氧化状态，有利于冠心病的一致和二级预防。     

高血压患者脂质过氧化物及白细胞介素Ⅱ的相关性

目的探讨脂质过氧化物（ＭＤＡ）及白细胞介素Ⅱ（ＩＬ－２）。方法用硫代巴比妥酸微量法及双抗夹心法测定４６例高血压患者及２０例健康的ＭＤＡ和ＩＬ－２。结果高血压患者ＭＤＡ明显高于健康对照组（Ｐ＜０．０５）而高血压患者ＩＬ－２明显低于对照组（ｒ＝－０．７３２，Ｐ＜０．０５）。结论高血压患者存在ＭＤＡ和ＩＬ－２异常，ＩＬ－２与ＭＤＡ有内在联系，氧自由基（ＯＦＲ）损伤淋巴细胞可能是导致ＩＬ－２异常的原因之一。     

Preservation of Red Blood Cells: Content of Microaggregates and Di-2-Ethylhexylphthalate (DEHP) in Red Blood Cells Stored in Saline-Adenine-Glucose-Mannitol (SAGM) Medium

The content of microaggregates was determined in leukocyte-poor red blood cells (RBC) after 5 weeks of storage in citrate-phosphate-dextrose (CPD)-adenine plasma and in saline-adenine-glucose-mannitol (SAGM) medium. The size range was 3,600-200,000 fl, corresponding to a particle diameter of 19-73 micron, presuming a spherical particle shape. In comparison with CPD-adenine whole blood (100%), the total number of particles per unit of RBC was found to be 41.2% (CPD-adenine anticoagulant) and 25.4% (SAGM medium). The corresponding data for total particle volumes were 43.3 and 30.3%. The significant differences between the two categories of RBC could not be explained on the basis of differences concerning pH or cell composition. A majority of particles (50-62%) was observed in the lowest size range (19-29 microns), corresponding to only 18-26% of the total particle volume. The accumulation of di-2-ethylhexylphthalate (DEHP) was determined in two variations of RBC stored in SAGM medium and in RBC stored in CPD-adenine plasma. The quantities of DEHP per unit of RBC after 5 weeks were significantly smaller in SAGM medium (9.0 +/- 3.6 and 22.7 +/- 6.1 mg, respectively) compared to CPD-adenine plasma (30.1 +/- 9.5 mg).     

Extended Storage of Single-Donor Apheresis Platelets in CLX® Blood Bags: Effect of Storage on Platelet Morphology, Viability and in vitro Function

A CLX (Cutter Laboratories, Berkeley, Calif.) bag system was evaluated for storage of single-donor apheresis platelets collected with the Haemonetics V-50 blood processor. Concentrates (n = 21) containing 3.9-5.2 x 10(11) platelets in 292 (+/- 41.8) ml were stored in two 1-liter bags for 7 days at 22 degrees C. pH was well maintained, declining from an initial pH of 7.0 (+/- 0.04) to 6.92 (+/- 0.20) after 7 days. Platelet morphology, response to a hypotonic stimulus and aggregation induced by paired agonists (epinephrine and ADP, or collagen) were also well-preserved. Concentrates with a wide variation of platelet yields (2.0 greater than or equal to 5.2 x 10(11), n = 43) also maintained pH (6.96 +/- 0.26), morphology and aggregation when stored for 7 days. All platelet concentrates (n = 64) were sterile at collection. Single-donor apheresis platelets may be stored in this bag system for up to 7 days.     

辛伐他汀对不稳定型心绞痛患者血脂和炎症指标的影响

目的 观察辛伐他汀治疗不稳定型心绞痛患者15天后血脂、高敏C反应蛋白、一氧化氮、丙氨酸氨基转移酶和肌酸激酶的变化.方法 将98例不稳定型心绞痛患者随机分为20 mg/d辛伐他汀组(34例)、40 mg/d辛伐他汀组(32例)和时照组(32例);所有病例均测定治疗前及治疗15天后血脂、高敏C反应蛋白、一氧化氮、丙氨酸氨基转移酶和肌酸激酶的变化.结果 辛伐他汀治疗组治疗前后比较以及与对照组比较,血脂、高敏C反应蛋白明显下降(P<0.05),且40 mg/d组下降更明显;辛伐他汀治疗后两组丙氨酸氨基转移酶水平升高,但均未超出正常值3倍;一氧化氮和肌酸激酶治疗前后差异无显著性.结论 在不稳定型心绞痛早期使用较大剂量辛伐他汀治疗15天,可明显且安全地减轻炎症,降低血脂.     

普伐他汀与烟酸肌醇单用和合用对高脂血症的疗效观察

为比较普伐他汀和烟酸肌醇单用和合用对高脂血症病人血脂的影响，将高脂血症患者分成普伐他订组、烟酸肌醇组和联合用药组，观察治疗前后血脂的变化。结果发现，晋代他汀组血清总胆固醇从7．0±1．4降至5．9±1．5mmol／L（P＜0．05），低密度脂蛋白胆固醇从4．6±1．3降至3．6±1．2mmol／L（P＜0．05），而甘油三酯无明显降伏。烟酸肌醇组甘油三酯从2．7±1．2降至2．1±0．9mmol／L（P＜0．05），而总胆固醇和低密度脂蛋白胆固醇无明显降低。两药治疗后高密度脂蛋白均无显著性变化（P＞0．05）。联合用药组治疗后血脂各项指标降低或升高的幅度均比普代他汀组和烟酸肌醇组大，总胆固醇分别降低27.3％、15.6％和7.5％（P＜0．05），甘油三酯分别降低31．9％、7．1％和22．8％（P＜0．05），高密度脂蛋白分别升高11．2％、1．7％和4．49％（P＜0．05）。单一治疗无效的39例高脂血症患者分别联用烟酸肌醇或普伐他汀，观察4周，发现血总胆固醇从6．5±1．4降至4.5±1．3mmol／L（P＜0．01），血甘油三酯从2．6±1．2降至1．9±1．lmmol／L（P＜0．01），高密度脂蛋白从1．16±0．22升至1．27±0．21mmol／L（P＜0．05）。提示普代化汀加烟酸肌醇联合治疗可增强降脂效果，改善血脂组成。     

通心络联合曲美他嗪对冠心病PCI术后心绞痛患者高敏C反应蛋白及血脂的影响

目的观察通心络联合曲美他嗪对冠心病经皮冠状动脉介入治疗(PCI)术后心绞痛的疗效,及对血清高敏C反应蛋白(hs-CRP)和血脂的影响。方法 80例PCI术后再发心绞痛患者随机分为治疗组和对照组各40例。对照组给予阿司匹林、氯吡格雷、硝酸脂类、低分子肝素、β-受体阻滞剂、钙离子拮抗剂、他汀类药物等,治疗组在此基础上加用通心络及曲美他嗪。两组治疗均为4周,观察患者临床症状改善情况及hs-CRP、血脂水平。结果治疗后治疗组和对照组的总有效率分别为90.00%和67.50%,治疗组明显优于对照组(P<0.01)。两组患者hs-CRP水平较治疗前明显下降,治疗组更为明显(P<0.05)。两组治疗后总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平较治疗前均有下降(P<0.05)。其中TC、LDL-C两组治疗后比较,治疗组较对照组下降更明显(P<0.05)。治疗组在用药过程中未见不良反应。结论采用治疗组的方法能显著改善冠心病PCI后心绞痛的临床症状,并能抑制炎性反应,调整血脂,防止斑块破裂,是辅助治疗冠心病PCI术后心绞痛的一种安全有效的方法。     

血脂康对2型糖尿病伴高脂血症患者血脂、血糖代谢的影响

目的探讨血脂康对2型糖尿病伴高脂血症患者血脂、血糖代谢的影响。方法将60例2型糖尿病伴高脂血症患者随机分为两组,在维持原糖尿病治疗方案的同时治疗组30例加服血脂康1．2g/d,对照组30例加服复合维生素B,4片/d。观察两组患者治疗前、治疗后3、6个月血脂六项、空腹血糖(FPG)变化、肝肾功能等,并记录药物的不良反应。结果治疗纽3个月后Tc、TG、LDL—C均有下降,6个月后TC、TG、LDL—C、apoB、FPG下降,HDL—C、apoAl升高,差异均有显著性意义(P＜0．05)；对照组治疗前与治疗后3、6个月血脂、血糖各项指标无显著改变(P＞0．05)。两组患者治疗后3个月TC、TC、LDL及治疗后6个月血脂六项、血糖间差异均有显著性意义(P＜0．05)。结论血脂康治疗伴有高脂血症的糖尿病患者不仅能改善脂质代谢,还能改善糖代谢。     

两种调脂治疗方案对老年高脂血症患者疗效及预后比较

为探讨不同降脂治疗方案对老年人血脂增高的疗效及预后。将 95名血脂增高离退休干部随机分成三组 :两年组用氟伐他汀隔晚 2 0mg,服用两年 ;3月组用氟伐他汀每晚 2 0mg,服用三个月 ;对照组不用降脂药 ;三组都观察两年。结果发现 ,观察三个月后 ,与对照组比较 ,两治疗组的总胆固醇和低密度脂蛋白胆固醇均较治疗前下降 ,3月组下降更明显 ,差异有显著性统计学意义 (两年组为P <0 .0 5 ,3月组为P <0 .0 1) ;观察两年后 ,两治疗组的总胆固醇和低密度脂蛋白胆固醇均较治疗前下降 ,两年组下降更明显 (两年组为P <0 .0 0 1,3月组为P <0 .0 5 ) ;对照组的总胆固醇和低密度脂蛋白胆固醇的差异无显著性 (P >0 .0 5 )。组间比较 ,观察两年后两年组 (与治疗前相比总胆固醇下降 2 3.4 % ,低密度脂蛋白胆固醇下降 2 5 % )较 3月组 (总胆固醇下降 9.5 % ,低密度脂蛋白胆固醇下降11.1% )下降明显 ,差异有显著性 (P <0 .0 5 )。两年组心血管事件发生率 (9% )明显低于对照组 (5 6 .2 % )和 3月组(31.2 % ) ,差异有显著性 (分别为P <0 .0 1和P <0 .0 5 )。结果提示 ,老年人长期服用降脂药有效安全 ,能明显减少冠心病等心血管事件的发生。     

Increased incidence of second neoplasms in patients treated with interferon alpha 2b for hairy cell leukemia: a clinicopathologic assessment [see comments]

We report that there is an unexpectedly high incidence of second neoplasms in patients after treatment of hairy cell leukemia (HCL) with interferon alpha 2b (IFN). In a cohort of 69 patients with HCL entered in a protocol using IFN as the primary treatment, and followed thereafter for a median of 91 months (range, 0.2 to 109 months), 13 patients (19%) developed a second neoplasm. Six neoplasms were of hematopoietic origin, whereas the remaining seven were adenocarcinomas. The expected number of second tumors in this cohort is three (based on calculations from the National Cancer Institute's SEER data), so the excess frequency (observed:expected) is 4.33. However, the excess frequency is even greater for the hematopoietic neoplasms; the expected frequency is 0.15, whereas six hematopoietic tumors occurred, for an observed:expected ratio of 40. In general, the second neoplasms have behaved aggressively, and the median survival after diagnosis of the second neoplasm was only 8.8 months. Although we cannot entirely exclude the possibility that IFN therapy has some direct oncogenic effect, we suspect that increased frequency of second tumors is related to prolonged survival of patients who are immunocompromised because of HCL and thus prone to develop second tumors. If so, the frequency of second neoplasms in patients with HCL may be even greater in the future with continued improvements in therapy.     

Increased [18F]fluorodeoxyglucose accumulation in right ventricular free wall in patients with pulmonary hypertension and the effect of epoprostenol

OBJECTIVES: We examined whether right ventricular (RV) [(18)F]fluorodeoxyglucose (FDG) accumulation is increased in patients with pulmonary hypertension using gated positron emission tomography (PET) and whether RV FDG accumulation changes after therapy with epoprostenol. BACKGROUND: Myocardial glucose utilization is increased in animal models with ventricular pressure overload. METHODS: We performed gated FDG-PET in 24 patients with pulmonary hypertension. The RV standardized uptake value (SUV) of FDG was corrected for the partial volume effect based on the wall thickness measured by electron-beam computed tomography or magnetic resonance imaging. RESULTS: The corrected RV SUV of FDG was significantly correlated with the pulmonary vascular resistance, mean pulmonary artery pressure, right atrial pressure, RV wall stress, and plasma brain natriuretic peptide levels, but not with the RV wall thickness and mass. After pulmonary vasodilator therapy with epoprostenol for three months, the corrected RV SUV of FDG significantly decreased in the responders, but not in the non-responders, and the percentage change of the corrected RV SUV of FDG was significantly correlated with the percentage change of the pulmonary vascular resistance (r = 0.78; p < 0.01) and RV systolic wall stress (r = 0.76; p < 0.05). CONCLUSIONS: The RV FDG accumulation corrected for the partial volume effect was significantly increased in accordance with the severity of the RV pressure overload (i.e., the RV peak-systolic wall stress) in patients with pulmonary hypertension. Furthermore, the corrected RV FDG accumulation was decreased after the treatment with epoprostenol in accordance with the degree of reduction in the pulmonary vascular resistance and RV peak-systolic wall stress.     

血脂、胆红素、尿酸水平对诊断2型糖尿病合并冠心病的意义

目的 研究2型糖尿病合并冠心病患者实施血脂、胆红素、尿酸检验的诊断效果.方法 于2018年7月—2019年7月选择该院纳入的40例2型糖尿病合并冠心病患者为实验组,选取同期40名健康群体为参照组,全部实验对象予行血脂、胆红素、尿酸检验,讨论患者及健康群体的血脂、胆红素、尿酸水平.结果 ①实验组总胆红素、直接胆红素、间接...     

阿卡波糖与二甲双胍在老年2型糖尿病患者中的应用及对血脂水平的影响研究

目的 探讨阿卡波糖与二甲双胍在老年2型糖尿病患者中的应用及对患者血脂水平的影响.方法 选取2018年12月—2020年3月在该院接受治疗的120例2型糖尿病患者,采用随机分配的方式将其平均分为对照组与研究组,研究组患者给予阿卡波糖与二甲双胍联合治疗,对照组患者单纯实施二甲双胍治疗.对比两组患者治疗效果及患者血脂水平改善...     

贞芪活血汤治疗冠心病血脂代谢异常阴虚血瘀证的临床观察

目的 观察贞芪活血汤治疗冠心病血脂代谢异常之肝肾阴虚证的临床疗效.方法 92例冠心病血脂代谢异常之肝肾阴虚证患者随机分为治疗组(50例)和对照组(42例).对照组予常规基础治疗(饮食调节十运动锻炼及戒烟等生活方式改变)加阿托伐他汀.治疗组在对照组基础上加用贞芪活血汤,每日1剂.观察两组患者入院第1天及治疗后180 d的血总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、心电图及舌脉象的变化,并进行两组间比较.结果 治疗组和对照组比较,入院后第1天,血脂、心电图ST -T段、中医症状疗效无统计学意义;治疗后180 d各指标比较有统计意义(P＜0.05).结论 贞芪活血汤可以改善冠心病患者的血脂代谢,从而改善心肌缺血.贞芪活血汤可改善阴虚血瘀证,从而达到阴阳平衡、气血通畅之效.